Retirement Realities

Background Access to comprehensive sexuality education (CSE) is crucial for adolescent health and well-being. Following UNESCO’s recommendations, Gabon revised its sex education policy in 2017 to better address adolescents’ sexual health needs. This study aims to map the capacities of the public health and education sector to implement Gabon’s CSE policy. Methods Semi-structured interviews were held with 15 professionals from ministries, NGOs, and development partners. Thematic analysis guided by Aluttis et al’s public health capacity model allowed to assess the existing capacities and gaps in leadership, organizational structures, partnerships, resources, and knowledge development for CSE. Results The implementation of CSE in Gabon is hindered by sociocultural and political factors, including the taboo on adolescent sexuality influencing perceptions of CSE content, natalist policies, and socio-economic disparities. Governmental involvement in CSE is limited to key ministries. Organizational structures for CSE lack cohesion due to changes in governance regimes and a lack of support for civil society organizations. Human resources are unevenly distributed, and financial constraints impede government initiatives, causing a strong reliance on external funding. An important role in supporting CSE is played by development partners and partnerships between stakeholders. While knowledge development for CSE is underway, monitoring and evaluation procedures are insufficient, and evidence mobilization by key professionals is insufficient. Conclusions Enhancing stakeholder collaboration, addressing structural constraints, and mobilizing human and financial resources are critical for effective CSE implementation in Gabon. Addressing these barriers requires coordinated efforts among stakeholders and addressing systemic challenges. This study provides insights for policymakers and practitioners to strengthen CSE programs and promote adolescent sexual health in Gabon. Key messages • CSE implementation is hindered by taboos on adolescent sexuality, natalist policies, and socio-economic gaps. • Evaluation and evidence mobilization deficits limit effectiveness.

THE FUTURE OF THE COMMON SECURITY DEFENCE POLICY AND A CONSTITUTIONAL QUESTION

Background Health literacy refers to the ability to understand, access and use health information and services. Limited parental health literacy is associated with ineffective preventive behaviours and worse child health outcomes. Limited financial and social resources are associated with low health literacy. Profiling the health literacy strengths and limitations of individuals allows the multidimensional nature of health literacy to be considered and highlight patterns of need. This study aims to identify the health literacy profiles of parents using family hubs in two disadvantaged UK regions using the Optimising Health Literacy and Access framework. Methods A mixed method study using the Health Literacy Questionnaire Parent (HLQ-Parent) and semi-structured focus groups was conducted among parents attending family hubs or libraries in two cities. Hierarchical cluster analysis was conducted to identify clusters with varying health literacy strengths and needs based on the HLQ-Parent domains. Clusters were translated into health literacy profiles using HLQ-Parent patterns and demographic data. Then, using an explanatory sequential approach, vignettes were created to represent the different health literacy profiles. Results Participants’ (n = 175, age range 18-59 yrs., mean age 33 yrs., 98% female) lowest mean HLQ-Parent score in city 1 was present in domain 4 “Social support for health” and domain 2 “Having sufficient information to manage my child's health” in city 2. Eight clusters were identified each with unique health literacy profiles. Both cities had one cluster (44% of participants) scoring highly on all domains and one cluster (20% of participants) reported difficulties across all domains. Conclusions Eight distinct health literacy profiles were identified among parents attending family hubs. These profiles in vignette format will facilitate the co-design and co-development of parental health literacy interventions. Key messages • This study emphasises the health literacy challenges faced by parents in disadvantaged areas, and the potential barriers they face in navigating and using health services for their children. • The vignettes developed in this study provide an authentic description of the health literacy profiles of parents in this context proving a promising starting point for co-designing interventions.

Simulation technologies (ST) in health and medical education are undergoing rapid development due to the undoubted advantages of the methods and forms of simulation used - high quality, significant efficiency, economy, reliability and safety for the patient. At the same time, the application of ST is still underrepresented in the education of health care students. The main aim of this study was to identify the barriers and perspectives for the application of ST in the education of health professional students in Bulgaria from the perspective of the respondents’ expertise. A qualitative study of the expert (n = 17) opinion of those directly involved in the introduction, application, and evaluation of the use of ST in the education of healthcare students was conducted in 2023 in Varna. The questionnaire regarding the barriers and perspectives in the use of ST in the education of undergraduate and postgraduate students in health specialties students was used. The main barriers to the widespread use of ST in the training of students were identified as follows: the lack of adapted curricula that combine traditional practical sessions with patients and those on simulators; the lack of a sufficient number of trained and motivated trainers; the reluctance of trainers to introduce or more widely use ST; lack of or insufficient space to locate a simulation centre or equipment in relevant core units; the high cost of purchasing and maintaining ST and limited financial resources, as well as the large number of students in the groups. According to one of the experts, ‘there are no barriers to the use of ST, but real patient contact and a personalized approach to the patient is impossible to replicate through technology,’ highlighting the importance in combining traditional training with real patients and modern with the use of technology. Ethical issues in training healthcare professionals with simulators appear to be a new aspect of medical education with the application of ST. Key messages • In the effort for widespread implementation of ST in the training of health professions students, it is important to achieve a balance with traditional training experienced with real patients. • Identifying and overcoming barriers is an important prerequisite for the rapid and widespread application of ST in the training of health care students.

Background The number of years - and healthy years - a person is expected to live differs according to gender: women tend to live longer than men, but with a shorter healthy life expectancy (HLE). Power imbalance, such as income, prestige, or autonomy gaps, may lead to an unequal health distribution across gender in the older ages. The association between gender equality and longer life expectancies has been described, but little is known about its association with HLE. We aimed to study the association between gender equality, and its components, and HLE in Europe, in the last decade. Methods We combined HLE estimates from Eurostat with the Gender Equality Index (and its components) for 27 European countries, from 2013 to 2019. The associations between gender equality and HLE, and its gender gap, were assessed using regression analyses adjusted for Gross Domestic Product, number of medical doctors per 1000 inhabitants (as proxies of economic wellbeing and access to healthcare), and year. Results Higher gender equality was associated with longer HLE in men (β = 0.22 p < 0.01), but not in women. Yet, higher equality in education was associated with longer HLE in both genders (βmen=0.49, βwomen=0.40, p < 0.001), as was access to financial resources (βmen=0.27, βwomen=0.20, p < 0.005), and social power (βmen=0.09, βwomen=0.07, p < 0.05). Differently, equality in participation in full-time work was associated with shorter HLE in both genders (βmen=-0.33, βwomen=-0.30, p < 0.001) and a higher HLE gender gap (β = 0.05, p < 0.05). The HLE gender gap was smaller in contexts with higher equality in access to financial resources (β=-0.06, p < 0.001) and education (β=-0.04, p < 0.01). Conclusions These results point to a country-level relation between gender equality and HLE. Beyond the social issue, gender inequalities in education, income and social power seem to play a role in the health of women and men through their aging course. Key messages • Higher gender equality in education, income and social power are associated with longer healthy life expectancies in 27 European countries. • Gender equality benefits not only women’s healthy life expectancies but also men’s, and is reflected in smaller gender gaps.

The war in Ukraine has significantly affected the access to safe water, sanitation and hygiene services (WASH) due to a widespread deterioration in water quality, destruction of infrastructure, disruption of power supplies, reduced financial resources, displacement of the population, and shortages in the workforce. The destruction of Kakhovka dam in 2023 caused widespread water scarcity in the south. Ensuring safe water supply became critical for protecting public health of the affected population. During the ongoing war the WASH sector continues to face multiple, compounding challenges that require coordinated responses and proactive preparedness. The response to these challenges highlighted a significant gap in global WASH guidance for conflict situations in industrialized countries. Responding to these challenges, the World Health Organization developed checklists to strengthen emergency preparedness and response to WASH services in conflict settings, which can be adapted for other industrialized country contexts. The aim of this undertaking was to develop rapid assessment checklists that support situation assessments to enhance the resilience of WASH systems to military attack, and to help ensure the maintenance, or rapid restoration of WASH services in case of disruption. The work was carried out during 2022- 2024 and involved various methods, such as consultations with a diverse range of stakeholders, series of focus group discussions with direct engagement of affected communities. This undertaking aimed to answer the following question - what are the priority actions needed to progressively improve WASH emergency readiness in a given conflict context? The result is a practical tool for guiding local authorities to set priorities and progressively improve WASH emergency readiness with a focus on protecting public health, thereby strengthening health security. The tool is adaptable to be utilized in conflict-affected settings and during public health emergencies. Key messages • The guidance with checklists provides an innovative tool to support coordinated efforts to enhance the resilience of WASH services in emergency settings, including conflict. • The checklist application facilitates a participatory approach through the extensive consultations with key WASH stakeholders concerned with emergency readiness.

ObjectivesIn this paper we discuss the main ethical challenges related to the conduct of medicine quality surveys and make suggestions on how to address them.MethodMost evidence‐based information regarding medicine quality derives from surveys. However, existing research ethical guidelines do not provide specific guidance for medicine quality surveys. Hence, those conducting surveys are often left wondering how to judge what counts as best practice. A list of the main ethical challenges in the design and conduct of surveys is presented.Results and conclusionsIt is vital that the design and conduct of medicine quality surveys uphold moral and ethical obligations and analyse the ethical implications and consequences of such work. These aspects include the impact on the local availability of and access to medicines; the confidentiality and privacy of the surveyors and the surveyed; questions as to whether outlet staff personnel should be told they are part of a survey; the need of ethical and regulatory approvals; and how the findings should be disseminated. Medicine quality surveys should ideally be conducted in partnership with the relevant national Medicine Regulatory Authorities. An international, but contextually sensitive, model of good ethical practice for such surveys is needed.

Purpose Academics examining the global South who engage in informal politics to understand social and political issues should be prepared to diversify their methods toolkit. Informal ties and politics are where one learns about social and economic exclusion. The paper aims to discuss these issues. Design/methodology/approach Mixed qualitative methods – such as individual interviews, surveys, and focus groups – provide an understanding of the people’s perspective, enabling the researcher to truly know what is going on. Findings Fieldwork in the downtown communities of Kingston, Jamaica, has an element of danger because violence and politics are very much a part of the daily reality of the people being interviewed. In this paper, the author argues that studying how financial resources are allocated to low-income people and understanding why some groups purposefully self-exclude themselves from economic development programs require unorthodox field methods. The author thus uses political ethnography to understand the experience of marginalized Jamaican people. Originality/value Mixed qualitative methods and political ethnography assisted the author to understand the actual experience of marginalized people and politicized financial programs.

The investments needed to deliver sustainable water and sanitation services, including the funds that are needed to operate and maintain the infrastructure, expand their coverage and upgrade service delivery to meet current social and environmental expectations, are huge. Yet, most systems are underfunded with dire consequences for water and sanitation users, especially the poorest. Providing sustainable drinking water supply and sanitation services requires sound financial basis and strategic financial planning to ensure that existing and future financial resources are commensurate with investment needs as well as the costs of operating and maintaining services. Some of the key messages of this report are: This title belongs to OECD Report Series . ISBN: 9781780406039 (eBook) ISBN: 9781780400327 (Print)